Many Veterans With Diabetic Kidney Disease Might Remain Undiagnosed

CHICAGO — The authors of a new study suggested their findings might warrant a revision of diabetic kidney disease (DKD) patient identification and management in U.S. veterans.

Embarking on the study, researchers from the University of Illinois in Chicago, the University of Utah in Salt Lake City and the VA Salt Lake City Healthcare System, wrote, “With a large number of patients and high mortality, diabetic kidney disease (DKD) imposes a significant burden on U.S. healthcare”. Although diabetes is the leading cause of chronic kidney disease and complications, the epidemiology of DKD in the contemporary U.S. veteran population is generally unknown.

The study team sought to estimate the rate of DKD progression and to measure the general epidemiology of DKD in the veteran population. To do that, a retrospective observational research using electronic health-care records and administrative databases was performed. Results were published in Diabetes, Metabolic Syndrome and Obesity.¹

The researchers abstracted the DKD patient cohort from VHA health records from January 2016 to March 2022. Laboratory test data based on Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guidelines were used to identify DKD patients.

The study involved 685,288 patients, 96% male and with a mean age of 2 years. Most, 64%, were Caucasian, and 87% were non-Hispanic.

The results indicated that the 5-year cumulative incidence of progression to an advanced DKD stage or all-cause death from DKD stages G1 A2/A3, G2 A2/A3, G3a, and G3b were 52.0%, 47.4%, 50.5%, and 60.9%, respectively. “In sum, 594,082 patients were classified as moderate or high risk as per KDIGO guidelines in 2021, and stages G3a and G3b accounted for 51.2% and 25.3%, respectively, of cases,” the authors wrote.

They added, “More than half of DKD patients underwent a stage progression or death within 5 years. A substantial number of DKD patients at an earlier stage might be left undetermined.”

1. Kim K, Crook J, Lu CC, Nyman H, Abdelaziz A, LaFleur J. Epidemiology of Diabetic Kidney Disease among US Veterans. Diabetes Metab Syndr Obes. 2024 Apr 8;17:1585-1596. doi: 10.2147/DMSO.S450370. PMID: 38616990; PMCID: PMC11011711.